Cinnamon in DIABETES MELLITUS PAGE 10

Does the Inclusion of Cinnamon in the Diet of Patients with Diabetes Mellitus Increase or Decrease A1C Levels?Heather ShepherdUniversity of New HampshireRunning head: Cinnamon in DIABETES MELLITUS 1

AbstractThis paper will address the PICO question, does the inclusion of cinnamon in the diet of patients with diabetes mellitus increase or decrease A1C levels? Four separate articles were found from databases accessed through the University of New Hampshire library website. All the articles concluded that cinnamon is not shown to lower A1C levels when introduced into the diets of participants with diabetes. These patients included the cinnamon into their diet anywhere from four to eighteen weeks. The dose of cinnamon used in these trials ranged from 120 milligrams to six grams in pill form. Placebo pills were used as a control in some of these trials. To effectively determine if cinnamon can help reduce A1C levels, future research must be done to further explore the effects of all species of cinnamon, all doses of cinnamon, and longer time frames used for research. After completing this additional research, nurses should not administer cinnamon to diabetic patients as it may be costly and timely with no added benefits to lowering A1C levels.

Diabetes mellitus is a disease that has become a major health concern in the United States within the last decade; there has been a significant increase especially in diagnoses of type two diabetes. Type two diabetes is related to patients weight and has started to affect the pediatric population. Hemoglobin A1C levels are a good indication of how well diabetes is managed in patients with this diagnosis. Without adequate control over blood glucose levels, multiple co-morbidities can be encountered later on in the lives of these individuals. Cinnamon is thought to lower the blood glucose levels of patients with diabetes because it contains substances that are said to have insulin mimetic properties. Further research must be done to determine if this spice can indeed lower blood glucose levels and ultimately lower the A1C levels of patients in this population. If cinnamon does initiate this positive effect, then this spice should be incorporated into new diet and education modifications for diabetics in nursing practice. Does the inclusion of cinnamon in the diet of patients with Diabetes Mellitus increase or decrease A1C levels? The author of this paper used the search engine, Ebsco Host, accessed through the UNH library website. After accessing this search engine, the databases CINAHL Complete and the Cochrane Database of Systematic Reviews were searched. Three key words were used to search these databases. These words were diabetes, A1C, and cinnamon. Limits to this search included, English language only, full text, abstract available, and peer reviewed. Four citations, three from CINAHL and one from the Cochrane Database of Systematic Reviews, were found. Inclusion criteria for this paper included that the articles analyzed must pertain to blood glucose levels of patients with diabetes mellitus, which may be type one and type two, and those patients must have cinnamon incorporated into their diet for an effective amount of time, which may be determined by individual studies. Exclusion criterion for this paper was the relation of cinnamon to blood glucose levels in patients who do not have diabetes mellitus. The first article that was analyzed is titled, Cinnamon use in type 2 diabetes: an updated systematic review and meta-analysis Allen, R., Schwartzman, E., Baker, W., Coleman, C., and Phung, O. (2013), provide a systematic review and meta-analysis of studies that looked at cinnamons effect on glycemic and lipid levels in the human body. The results concluded from this study included that cinnamon does correlate with a statistically significant reduction in levels of fasting glucose, total cholesterol, LDL levels, and triglycerides. It was also concluded that cinnamon increases HDL levels, often referred to as good cholesterol. Overall, A1C levels were not affected by the inclusion of cinnamon in the diabetic diet. A major strength of this study was the consistency used to lead to the certain outcomes. Cinnamon doses of 120 milligrams per deciliter to six grams per deciliter used over a period of four to eighteen weeks was implemented. A weakness of this study was that this certain dosage range of cinnamon and the time frame used for diet modifications may have not been effective. Perhaps if a wider range of doses and time frames were used, results would have shown that cinnamon does reduce A1C levels. Lastly, the preferred dose of cinnamon as well as the specific time frame of use was not clear to the reader. Low doses compared to high doses and four weeks compared to eighteen weeks was not analyzed. Therefore, patient education may be difficult if not impossible due to the lack of information. The next study that was found, The effect of cinnamon on A1C among adolescents with type 1 diabetes, by Altschuler, J., Casella, S., MacKenzie, T., and Curtis, K. (2007), was a double-blind, placebo controlled design. Within this study, seventy-two teens with type one diabetes were given a dose of one gram of cinnamon per day, or the same dose of a placebo spice. After ninety days, there was no significant decrease in A1C levels. There was also no significant difference in total daily insulin usage or number of hypoglycemic incidences with the use of cinnamon as compared to the placebo spice. A strength of this study was that patients took their pills at a time that was convenient for them and then continued to take those pills at the same time each day. They were also asked to keep a log of their insulin use and hypoglycemic episodes throughout the day over the ninety day period. This allows researchers to evaluate the possible negative effects of cinnamon incorporated into the participants diet. Weaknesses of this study were that participants were examined only every two weeks throughout the ninety day period. Also, some patients may have been able to tell the difference in appearance between the cinnamon pill and the placebo pill; therefore, outcomes could have been altered. Compliance may also have been an issue in this study and extensive nursing education should have been implemented. The third study found on the CINAHL database is titled, Effect of cinnamon on glucose control and lipid parameters. Baker, W., Guiterrez-Williams, G., White, C., Kluger, J., and Coleman, C. (2008), provided this literature review from which five randomized control trials were analyzed. It concluded that cinnamon did not decrease A1C levels. It also stated that finger stick blood glucose levels and lipid parameters were not improved by incorporating cinnamon into the diet of type one and type two diabetic patients. The average duration of time that these patients were included in these trials was twelve weeks. This duration is thought to be a weakness of the study. Researchers think that this time frame may be too short to lead to definitive conclusions about cinnamon in diabetic diets. However, researchers also identified that a small trend would have still been seen if cinnamon did indeed decrease, or increase, A1C levels. A strength of this study was that it only included clinical trials in the meta analysis as well as only trials using cinnamon. Information from other studies involving other spices were not included and did not affect information provided on how cinnamon affects diabetes. However, only six clinical trials were discovered and only five were utilized because one was not a trial using cinnamon as the primary spice. Another weakness of this study was that researchers hypothesized that if more patients were included, possibly 1,166 to 6,853 patients, then the results of the study may have been clinically significant. Such a large number of participants may be difficult to obtain as well as effectively monitor within the specific trial parameters. The final study that will be included in this paper to answer the authors PICO question was found on the Cochrane Database of Systematic Reviews. Leach, M. and Kumar, S. (2012), authored Cinnamon for diabetes mellitus. In this study, two reviewers independently selected control trials, assessed for bias, and gathered data. Ten randomized control trials were included in this review and a total of 577 patients with type one and two Diabetes Mellitus were included. The dose of cinnamon assessed was two grams daily for four to sixteen weeks. There was no correlation found between the incorporation of cinnamon into the diet and increased or decreased fasting blood glucose levels. There was no statistically significant difference between A1C levels of those patients who took the cinnamon dose and those who were given placebo doses. Weaknesses of this study included a high or unclear risk of bias in all trials except two and poor standards under which these trials were performed. This study suggested that additional research trials should be performed under better standards and more controlled settings as well as researching more species of cinnamon. Strengths of this study included that the two authors of this study independently searched and assessed databases to gather information and there was an assessment of bias to better analyze these trials. The presence of bias may have altered the conclusion of these trials which may have led researchers to consider not including trials with a very high risk of bias. After four articles were analyzed using data bases found through the UNH library website, the author of this paper concluded that cinnamon does not improve hemoglobin A1C levels in patients with diabetes mellitus. All studies concluded that there was no significant evidence showing that cinnamon lowered overall A1C levels. However, there was evidence to support that cinnamon can reduce fasting blood glucose levels and overall cholesterol levels. LDL levels were shown to decrease after the implementation of cinnamon into the diabetic diet while HDL levels were shown to increase. In relation to the initial question, cinnamon is an ineffective way to lower A1C levels of diabetic patients. If an adequate diet and enough exercise were also implemented into each of the subjects lives, perhaps the evidence would have shown that cinnamon has an additive effect to lowering A1C levels. Because subjects were not clearly described, we cannot conclude that this would make a difference in the evidence found. We only know that the participants used in these studies were diabetic. Much like implementing only an exercise regimen or only improving ones diet, cinnamon is not shown to act independently on reducing long term blood glucose levels. As previously mentioned, if all participants were to comply with proper diabetic lifestyle modifications, perhaps cinnamon could act as a catalyst to decreasing the A1C levels of diabetic patients.Cinnamon has been shown to affect A1C levels on animals but fewer trials have been performed on humans. There are multiple species of cinnamon that have been used in trials that have taken place but not all species have been used. For future reference, more human trials must be performed. All species of cinnamon must be incorporated into these additional research trials. A larger group of diabetic participants must also be utilized. In the past, trends have failed to surface from current research. Perhaps if more people participated, trends would become more obvious to researchers. Another consideration of this research question is perhaps past trials have not lasted long enough. Eighteen weeks is the longest amount of time that participants included cinnamon into their diets. Perhaps an entire year must pass before A1C levels are shown to decrease. Any further studies done to answer this PICO question must extend the time frame of the previous studies. All doses of cinnamon must also be analyzed and used in future trials. The maximum dose of cinnamon that can be taken in a single day is thought to be no more than six grams. Instead of just using a cinnamon pill and a placebo pill for participants, a placebo pill and differing dosages of cinnamon pills should be utilized among groups of the participants. A larger population of diabetic patients will be needed for this future research in order to better understand how the overall diabetic population may react to this treatment. Additional research would be beneficial to conduct in order to get a clear understanding of how cinnamon can affect A1C levels in diabetic patients. Anything that can reduce A1C levels and better control blood glucose levels will help with the management of diabetes in the healthcare system. Type two diabetes especially will be a continuing problem seen in hospitals and other health care facilities. Other than diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome, co-morbidities of diabetes are difficult to manage by patients and the healthcare team. Compliance is a major issue in this population, especially with weight management in type two diabetes. If a cinnamon pill, taken once a day, could create an additive beneficial effect of lowering fasting blood glucose levels and thus A1C levels, then a reduction in co-morbidities and other diabetic complications may also be seen. Along with all the trial standard adjustments, participants of future trials must also be able to alter their lifestyles. Adequate food choices and exercise must be implemented, if not already in place. Once these changes are made and blood glucose levels are more controlled, then cinnamon can be added into the diet of these individuals to determine if cinnamon can further improve A1C levels. Unless additional research can provide evidence that cinnamon does reduce A1C levels, the use of this spice is not recommended to include in the diet of diabetic patients. It may be costly and timely to provide cinnamon pills as well as education on how it may or may not be effective in the diet. Therefore, with the information provided in this paper, cinnamon should not be given to patients with diabetes. It should also not be included in any patient education by the nurse as it is not necessary or beneficial.

Works CitedAllen, R., Schwartzman, E., Baker, W., Coleman, C., & Phung, O. (2013). Cinnamon use in type 2 diabetes: An updated systematic review and meta-analysis. Annals of Family Medicine, 5(1544-1709), 452-459. Retrieved March 17, 2015, from CINAHL Complete. Altschuler, J., Casella, S., MacKenzie, T., & Curtis, K. (2007). Effect of cinnamon on A1C among adolescents with type 1 diabetes. Diabetes Care, 4(0149-5992), 813-816. Retrieved March 17, 2015, from CINAHL Complete.Baker, W., Guiterrez-Williams, G., White, C., Kluger, J., & Coleman, C. (2008). Effect of cinnamon on glucose control and lipid parameters. Diabetes Care, 1(0149-5992), 41-43. Retrieved March 16, 2015, from Cochrane Database of Systematic Reviews. Leach, M. & Kumar, S. Cinnamon for diabetes mellitus. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD007170. DOI: 10.1002/14651858.CD007170.pub2.Roth, E. (2014, June 23). Can Cinnamon Ease Diabetes Symptoms? Retrieved March 17, 2015, from http://www.healthline.com/health/can-cinnamon-ease-diabetes-symptoms#How?4